Correction: Implementation of Genomic Surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings.

[This corrects the article DOI: 10.1371/journal.pgph.0001455.].

Implementation of genomic surveillance of SARS-CoV-2 in the Caribbean: Lessons learned for sustainability in resource-limited settings.

The COVID-19 pandemic highlighted the importance of global genomic surveillance to monitor the emergence and spread of SARS-CoV-2 variants and inform public health decision-making. Until December 2020 there was minimal capacity for viral genomic surveillance in most Caribbean countries. To overcome this constraint, the COVID-19: Infectious disease Molecular epidemiology for PAthogen Control & Tracking (COVID-19 IMPACT) project was implemented to establish rapid SARS-CoV-2 whole genome nanopore sequencing at The University of the West Indies (UWI) in Trinidad and Tobago (T&T) and provide needed SARS-CoV-2 sequencing services for T&T and other Caribbean Public Health Agency Member States (CMS). Using the Oxford Nanopore Technologies MinION sequencing platform and ARTIC network sequencing protocols and bioinformatics pipeline, a total of 3610 SARS-CoV-2 positive RNA samples, received from 17 CMS, were sequenced in-situ during the period December 5th 2020 to December 31st 2021. Ninety-one Pango lineages, including those of five variants of concern (VOC), were identified. Genetic analysis revealed at least 260 introductions to the CMS from other global regions. For each of the 17 CMS, the percentage of reported COVID-19 cases sequenced by the COVID-19 IMPACT laboratory ranged from 0·02% to 3·80% (median = 1·12%). Sequences submitted to GISAID by our study represented 73·3% of all SARS-CoV-2 sequences from the 17 CMS available on the database up to December 31st 2021. Increased staffing, process and infrastructural improvement over the course of the project helped reduce turnaround times for reporting to originating institutions and sequence uploads to GISAID. Insights from our genomic surveillance network in the Caribbean region directly influenced non-pharmaceutical countermeasures in the CMS countries. However, limited availability of associated surveillance and clinical data made it challenging to contextualise the observed SARS-CoV-2 diversity and evolution, highlighting the need for development of infrastructure for collecting and integrating genomic sequencing data and sample-associated metadata.

Uptake and Outcomes Associated with Implementation of a Community-Based Voluntary HIV Counseling and Testing Program in Antigua and Barbuda.

OBJECTIVE: To evaluate the implementation of community-based voluntary HIV counseling and testing (CBVCT) in the Eastern Caribbean. METHODS: A total of 9782 unique HIV testing events performed through a national program of CBVCT in Antigua and Barbuda (2009-2012) were analyzed. The authors describe testers' demographic characteristics and assess demographic (education, housing, marital status, nationality, and age) and sexual exposure (partner gender, transactional sex, and multiple partners) factors associated with testing HIV-positivity and with condom use. RESULTS: Older men and men having sex with women and women with higher education, of Antiguan nationality, and having sex with men were less likely to test positive for HIV. Younger, educated, and unmarried men and women with multiple partners were more likely to report using condoms. CONCLUSION: The CBVCT model can be successfully implemented in Eastern Caribbean. Demographic differences persist in HIV testing, risk behavior, and infection among vulnerable populations and should be considered in HIV prevention intervention design.

The public health assessment of excreta disposal in the Kingston, St. Andrew

Excreta disposal in the Kingston, St. Andrew Metropolitan Area was assessed by performing an audit of the processes carried out by the National Water Commission (NWC) and by conducting a survey in the Kentyre area. The audit took the form of a review that served to establish the extent to which processes at the NWC conformed to predetermined standards set locally by the National Resources Conservation Authority (NRCA) and internationally by the Environmental Protection Agency (EPA) and the United Nations Environment Programme (UNEP). This audit was facilitated by: (a). site visits to sewage treatment plants operated by the NWC. (b). interviews with key personnel involved with excreta disposal (c). an examination of the records relating to the testing of the influent and effluent from sewage treatment plants within the Kingston, St. Andrew Metropolitan Area. A questionnaire instrument was administered to 40 randomly selected households in the Kentyre area to determine residents' knowledge, attitudes and practices towards excreta disposal. Of the 15 plants operated by the NWC in the KSA Metropolitan Area, five (33.3 percent) were primary facilities, nine (60 percent) were secondary and there was one (6.7 percent) was unsatisfactory and three (20 percent) were non-operational. All of the effluent from those plants that were operational was discharged into rivers and gullies and eventually flowed into the sea. Raw sewerage from plants which were non-operational also flowed into the sea. The site visits to the plants gave an insight to the operations at one tertiary and one secondary plant. These were in conformity with established processes for primary and tertiary facilities but there was concern practices such as the exposure of raw sewage to the environment and vectors, and unhygenic practices of workers. Monitoring of sewerage treatment plants of the National Water commission (NWC) is done both internally by the NWC and externally by the NRCA. Results of analysis for 1998 indicated that of the effluent samples evaluated for faecal coliform (n=57), 25/57 (38.6 percent) were satisfactory and 61.4 percent were unsatisfactory, using the NCRA standard of 1000 mpn/100mls. When compared to the effluent standard for BOD (20mg/l), the results showed that 38/68 or 59.9 percent of the individual readings were satisfactory and 30/68 or 44.1 percent unsatisfactory.(Au)